Oppositional Defiant Disorder (ODD) Parent HandoutAll children are oppositional from time to time, particularly when tired, hungry, stressed or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is often a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the childs social, family and academic life. In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngsters day to day functioning. Symptoms of ODD may include: * Frequent temper tantrums * Excessive arguing with adults * Often questioning rules * Active defiance and refusal to comply with adult requests and rules * Deliberate attempts to annoy or upset people * Blaming others for his or her mistakes or misbehavior * Often being touchy or easily annoyed by others * Frequent anger and resentment * Mean and hateful talking when upset * Spiteful attitude and revenge seeking The symptoms are usually seen in multiple settings, but may be more noticeable at home or at school. One to sixteen percent of all school-age children and adolescents have ODD. The causes of ODD are unknown, but many parents report that their child with ODD was more rigid and demanding that the childs siblings from an early age. Biological, psychological and social factors may have a role. A child presenting with ODD symptoms should have a comprehensive evaluation. It is important to look for other disorders which may be present; such as, attention-deficit hyperactivity disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder) and anxiety disorders. It may be difficult to improve the symptoms of ODD without treating the coexisting disorder. Some children with ODD may go on to develop conduct disorder. Treatment of ODD may include: Parent Management Training Programs to help parents and others manage the childs behavior, Individual Psychotherapy to develop more effective anger management, Family Psychotherapy to improve communication and mutual understanding, Cognitive Problem-Solving Skills Training and Therapies to assist with problem solving skills and decrease negativity, and Social Skills Training to increase flexibility and improve social skills and frustration tolerance with peers. Medication may be helpful in controlling some of the more distressing symptoms of ODD as well as the symptoms related to coexistent conditions such as ADHD, anxiety and mood disorders. A child with ODD can be very difficult for parents. These parents need support and understanding. Parents can help their child with ODD in the following ways: * Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation. * Take a time-out or break if you are about to make the conflict with your child worse, not better. This is

good modeling for your child. Support your child if he decides to take a time-out to prevent overreacting. * Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time-out in his room for misbehavior, dont add time for arguing. Say your time will start when you go to your room. * Set up reasonable, age appropriate limits with consequences that can be enforced consistently. * Maintain interests other than your child with ODD, so that managing your child doesnt take all your time and energy. Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child. * Manage your own stress with healthy life choices such as exercise and relaxation. Use respite care and other breaks as needed Many children with ODD will respond to the positive parenting techniques. Parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist or qualified mental health professional that can diagnose and treat ODD and any coexisting psychiatric condition. Following is some more technical information.

ODDOppositional defiant disorder is described by the Diagnostic and Statistical Manual of Mental Disorders as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior. People who have it may appear very stubborn. Contents DSM criteria To meet DSM-IV-TR criteria, certain factors must be taken into account. First, the defiance must interfere with the childs ability to function in school, home, or the community. Second, the defiance cannot be the result of another disorder, such as the more serious conduct disorder, depression, anxiety, or a sleep disorder such as DSPS. Third, the child's problem behaviors have been happening for at least six months. The diagnostic criteria for this disorder are as follows: Diagnostic Criteria 1. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present: Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level. 1. often loses temper 2. often argues with adults 3. often actively defies or refuses to comply with adults' requests or rules 4. often deliberately annoys people 5. often blames others for his or her mistakes or misbehavior 6. is often touchy or easily annoyed by others 7. is often angry and resentful 8. is often spiteful or vindictive 2. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. 3. The behaviors do not occur exclusively during the course of a psychotic or mood disorder. 4. Criteria are not met for conduct disorder, and, if the individual is age 18 years or older, criteria are not met for antisocial personality disorder. If the child meets at least four of these criteria, and they are interfering with the childs ability to function, then he or she technically meets the definition of Oppositional Defiant Disorder.

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Prevalence The DSM-IV-TR cites a prevalence of 2-16%, "depending on the nature of the population sample and methods of ascertainment."[2] Prognosis Childhood oppositional defiant disorder is strongly associated with later developing conduct disorder. Untreated, about 52% of children with ODD will continue to meet the DSM-IV criteria up to three years later and about half of those 52% will progress into Conduct Disorder. Controversy According to The American Journal of Psychiatry, there are several sources of controversy around the diagnosis of ODD. One concerns the fact that the DSM-IV criteria differ slightly from those of the World Health Organization's criteria, as outlined in the ICD-10. Diagnosis of ODD is further complicated by the high occurrence of co morbidity with other disorders such as ADHD, though a 2002 study provided additional support for the validity of ODD as an entity distinct from Conduct disorder. In another study, the utility of the DSM-IV criteria to diagnose preschoolers has been questioned because the criteria were developed using school-age children and adolescents. The authors concluded that the criteria could be used effectively when developmental level was factored into assessment. Information in this handout was provided by; www.aacap.org/cs/ODD.ResourceCenter www.wikipedia.com

ResourcesOnline Article on ODD interventions by Carolyn H. Webster-Strattonhttp://www.son.washington.edu/centers/parentingclinic/opendocs/Earlyintervention1996.pdf

Struggle for Control [DVD Video] : Child and Youth Behavior Disorders / Directed by Melanie Wood.Central Library i21328122 Call #: 362.2083 STR

Map This Location 735 Broughton Street Victoria, BC V8W 3H2 Tel: 250-382-7241 TTY: 250-413-0364 (For deaf and hearing impaired patrons) Fax: 250-382-7125

Child and Youth Mental HealthProvided by: Ministry of Children and Family Development

DescriptionProvides a wide range of direct and contracted community-based specialized mental health services to BC children and youth under the age of 19, and their families. Staff includes clinical social workers, psychologists, counsellors with masters degrees, and nurses who have training5

and expertise in child and youth mental health. Typically, staff and clients have access to consulting psychiatrists. Staff work to build community capacity and provide services to children and their families, including intake, screening and referral, assessment and planning, treatment, case management, and clinical consultation. Outpatient services are provided on a voluntary basis.

Mailing AddressP.O. Box 9731 PROV GOVT Ministry of Children and Family Development Victoria, BC, V8W 9S1

Contact InformationPhone: (250) 387-9749 Fax: (250) 356-0580 E-mail: MCF.ChildYouthMentalHealth@gov.bc.ca Website: http://www.mcf.gov.bc.ca/mental_health/index.htmReference # SV001016

LanguageEnglish, with written material available in Cantonese, Farsi, Korean, Mandarin, Punjabi and Vietamese Eligibility restrictions? Yes

Eligibility informationServices provided to children, youth and their families. Restricted to age range: 0 - 18 years.

Local SupportQueen Alexandra Centre for Children's Health, VictoriaQueen Alexandra Centre for Children's Health serves infants, children, and adolescents with physical, intellectual, social, or emotional challenges who require assessment, treatment, consultation, long-term and short-term follow-up or coordination of services. Services include: speech and language therapy; autism intervention; occupational therapy;

outreach and outpatient services for infants and children with physical and developmental disabilities; physical, professional and educational resources; rehabilitation engineering and research centre for orthotics, prosthetics, and seating; and a psychiatric unit for children and adolescents.

Contact: Queen Alexandra Centre for Children's Health Phone: 250-477-1826

2400 Arbutus Road Victoria BC

Island Pastoral Services Association of Victoria, VictoriaCounselling services available from a pastoral perspective for anyone regarding any issues.

Contact: Island Pastoral Services Phone: 250-472-2851

3821A Cedar Hill X Rd. Victoria BC

Federation of Invisible DisabilitiesVICTORIA SUPPORT GROUP

The Victoria Support Group is organized by parents of children with invisible disabilities (LD, ADD etc.) to help other parents learn about resources that are available to them, to discuss their concerns, to exchange information and to offer/receive emotional support. Meetings are held in Victoria at the Pearkes Arena on the second Monday of the month, in the Bell-Irving room and often feature guest speakers. For more information call Lisa at (250) 479-1192 or Robin Herron at (250) 744-1630.

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